News and Views for Healthcare Accreditation Professionals

It is common practice for orthopedic surgeons to request the addition of epinephrine to irrigation solutions for joint arthroscopy procedures. The question arose as to whether or not it would be required for pharmacy to admix this medication. This is the answer from SIG:

Original Question:
MM.05.01.07 EP 1 states that only a pharmacist or pharmacy staff may admix
medications except in urgent or emergent situations.
Would this standard apply to the following:
For an elective shoulder arthroscopy, the orthopedic surgeon asks
staff to add an amount of epinephrine
to an irrigation solution that will flush the joint during the procedure.
Would it be expected that pharmacy would prepare this admixture since there
is no urgent need, but a planned surgery?
Thank you.
SIG Response:
Thank you for your inquiry. Yes, if it is known prior to the procedure,
sterile irrigations would be included in the standard.